Laparoscopic surgery is a minimally invasive procedure that does not require a general anesthetic, incisions are small and the surgery is done through the flank under direct TV monitor visualization using a miniature camera telescope.
Small incisions are placed in the respective flank after infiltration with local anesthetic. The abdomen is inflated with carbon dioxide gas to increase visibility and allow room for placement of instruments. Hollow tubes called cannulas are placed through the incisions into the abdomen. These have valves on them preventing escape of the gas.
The interior abdominal pressure is monitored by the insufflation machine. The telescope camera is introduced through the top cannula and held by the assistant surgeon. The other two cannulas are used to introduce grabbers and high tech coagulating and stapling instruments operated by the surgeon. Specialized instruments are required for vessel sealing. (The LigaSure system ensures tissue is cut cleanly while blood vessels are sealed.) A team approach is important and the two surgeons work in concert with one another as they view the monitor.
At the completion of surgery one incision is enlarged enough to allow the small testicle to be “popped” out. Incisions are routinely closed with deep sutures and skin staples.
Laparoscopy is also a great option for spaying a mare. Spaying a mare can be done for several reasons including spaying the difficult mare that has temperament issues associated with heat periods and removing tumors of the ovary.
Granulosa cell tumors can be a cause of aggressive behavior in the mare. These tumors may grow to be quite large and cause infertility by suppressing the opposite ovary. We are able to seal all the numerous vessels easily and remove even large ovarian tumors through the flank. This has simplified this procedure and decreased complications.
Laparoscopy can also be used for internal examination of horses with chronic colic, bladder issues, organ biopsy and thoracoscopy.
Prior to the laparoscopic approach, major surgery was required for abdominal procedures such as a cryptorchid castration, where when one or both testicles have not descended. This surgery, performed under general anesthesia was typically done blindly using the “grope and hope” method. Because of the large incision in the ventral abdomen, recovery time was extensive and some complications could be fatal. The complications included infection and evisceration – the prolapse of intestines out of the abdomen through the incision. With new advances, a smaller incision is made, a scope is inserted into the abdomen and the testicle(s) can be located and removed with minimal invasion.
Preparation for a laparoscopy differs from that done under general anesthetic because the procedure is done standing. After the patient has been fasted for 24 hours, he is sedated, restrained in stocks and the flanks are surgically clipped and prepped. Sterile technique is used and the horse is fully draped. Catheterization is followed by administration of pre-op antibiotics and anti-inflammatories. Vital signs are monitored throughout the procedure with maintenance including IV fluids, supplemental pain medication and sedation as required.
Horses are usually discharged the day after surgery.
Post surgical care is minimal but should include:
– Daily monitoring of temperature and comfort level. Oral antibiotics and an anti-inflammatory are usually prescribed for the first few days.
– Bed on straw bedding and clean regularly to ensure a dry bed. This decreases contamination of the surgical sites.
– When possible keep a clean summer sheet on your horse. This also protects the surgical site when your horse lies down.
– Stall rest until staple removal at 12 days.
– Your horse may then start hand walking and gradually return to exercise.
Dr. Kleider was trained in laparoscopy by Dr. Hendrickson at Colorado State University in 2004. He brought the technology to BC where he now successfully completes dozens of laparoscopic surgeries annually.